RAJARATA UNIVERSITY OF SRI LANKA -2025
SPECIMEN APPLICATION FOR SUPPLIER REGISTRATION
01 Name of the Business organization / Contractor: -
…………………………………………………………………………………………………………………………………………………………..
02 Address of the Business Organization/ Contractor :-
…………………………………………………………………………………………………………………………………………………………..
03 Telephone/Fax Number: a. Office: …………………………………………………………………………………….
b. Mobile: ……………………………………………………………………………………
c. Fax: …………………………………………………………………………….……………
04 Email :- ………………………………………………………………………………………………………………………………………………
05 Contact Person: a. Name: - ……………………………………………………………………………….………………
b. Position: - ………………………………………………………………………….…………………
06 Tax Payer Identification Number (TIN) ……………………………………………………………………………………………..
07 VAT Registration Number:- ……………………………………………………………………………………………….………………
(Should attach the certified copy of VAT certificate)
08 Nature of organization:- …………………………………………………………………………………………………………………….
(Whether a Government owned venture, corporation, Institution, sole proprietor, partnership or
Limited liability Company, people’s Company or a Business Firm)
09 Whether Manufacturer, Sole Importer, Sole Agent, Sole Distributors or Stockiest, etc: -
………………………………………………………………………………………………………………………………………………………………
10 Name of the Owner: - …………………………………………………………………………………………………………………………
11 Registration Number: - ……………………………………………………………………………………………………………………..
(A copy of the certificate of Business Registration or CIDA should be attached)
12 Name of Bankers and Account Number: - …………………………………………………………………………………………..
13 Whether agreeable to give 30 days credit facility: - ……………………………………………………………………………..
14 Category numbers apply for supply registration (Pls. write the numbers)
15 Total Amount Paid: …………………………………………………………………………………………………………………………
(LKR 1,000.00 for each category)
Date ……………………………………… ………………………………….
Signature of Applicant
(Official Seal)